Jeanne A Mowry

Renal transplantation in children has been considered the treatment of choice for end-stage renal disease for many years [1]. Successful transplantation allows for improved physical, social, and psychological rehabilitation, enabling a child to have a quality of life that usually is not attainable with dialysis. Improvements in technology in pediatric transplantation have been significant in the 1990s; however, owing to the inherent potential risks and benefits, the optimal timing for transplantation needs to be individualized to the child. Currently, dialysis and transplantation need to be viewed as complementary parts of each child's lifelong treatment plan. Renal transplantation in children carries with it special issues and problems that vary somewhat from those in adult transplantation. Because children are constantly growing and developing, technical, metabolic, immunologic, and psychological factors exist that are unique to children and must be considered.

The current status of pediatric renal transplantation is reviewed, summarizing immunosuppressive regimens, outcomes, and complications. Because of the low incidence of end-stage renal disease in children, much of the information available about current practices and trends regarding pediatric renal transplantation has been collected by national registries. To supplement the United States Renal Data Source, the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) was initiated in 1987 in an effort to capture information to improve the care of pediatric renal allograft recipients. Current NAPRTCS data include information collected voluntarily from 123 centers on 3066 children who received renal transplantation on or after January 1, 1987 [2]. This registry has been helpful in providing a mechanism through which the clinical course of a large number of children can be evaluated.

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